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Restructure Restructure Medical StaffMedical Staff
Phase IIPhase II
Medical Staff HistoryMedical Staff History
1909 first Medical Staff was created 1909 first Medical Staff was created to monitor quality in hospitalsto monitor quality in hospitals
NO SIGNIFICANT CHANGE IN THIS NO SIGNIFICANT CHANGE IN THIS STRUCTURE IN 100 YEARSSTRUCTURE IN 100 YEARS
Medicine now changing at rapid rateMedicine now changing at rapid rate Pay-for-performance is Pay-for-performance is HEREHERE Current structure not agileCurrent structure not agile
PreludePrelude In 2000, at a Greeley Medical Staff Leadership In 2000, at a Greeley Medical Staff Leadership
Conference, we learned that most hospital have a Conference, we learned that most hospital have a two-year term for medical staff leaderstwo-year term for medical staff leaders
Looked at Medical Staff structures nation-wide and Looked at Medical Staff structures nation-wide and in our areain our area
Rapid turnover of medical staff leaders and senior Rapid turnover of medical staff leaders and senior administration pointed to need for longer termsadministration pointed to need for longer terms
We also researched with Health Care Advisory We also researched with Health Care Advisory Board and had initial planning retreat in January Board and had initial planning retreat in January with medical staff and Board.with medical staff and Board.
We have had two subcommittee planning meetings We have had two subcommittee planning meetings in February and March of 2006 to develop OUR in February and March of 2006 to develop OUR planplan
We found the best structure was at Northwest We found the best structure was at Northwest Hospital and adopted it as our initial frameworkHospital and adopted it as our initial framework
Prelude Cont.Prelude Cont.
2002 we implemented phase I of 2002 we implemented phase I of restructurerestructure
Started two-year terms for senior medical Started two-year terms for senior medical staff leadership, and created the Joint staff leadership, and created the Joint Operations CommitteeOperations Committee
We held off on phase II, due to financial We held off on phase II, due to financial concerns in early 2003concerns in early 2003
We have had 6 months where we have We have had 6 months where we have had a retreat and planning subcommittee had a retreat and planning subcommittee researching and revising our structureresearching and revising our structure
Subcommittee MembersSubcommittee Members
Ed EissmannEd Eissmann Tom SmithTom Smith Eli SaikalyEli Saikaly Kevin ClayKevin Clay Jeff WinninghamJeff Winningham Pat RyanPat Ryan Art GrossmanArt Grossman Ival SalyerIval Salyer Larry NicolovLarry Nicolov Jim BrevigJim Brevig Todd GundersonTodd Gunderson Larry SchecterLarry Schecter Janice HalladayJanice Halladay Bob McKnightBob McKnight Ruth FelthousRuth Felthous Judy GoodJudy Good Yvonne StraderYvonne Strader Sridar ChalakaSridar Chalaka
A Possible SolutionA Possible Solution
Unified Medical Staff ModelUnified Medical Staff Model Goal is to combine and streamline Goal is to combine and streamline
the medical directors as well as the the medical directors as well as the medical staff departments where medical staff departments where appropriate and practical to meet appropriate and practical to meet the rapid changes in healthcarethe rapid changes in healthcare
StructureStructure(Provisional)(Provisional)
CMOPRESIDENT/
MEDICAL STAFF
MedicineDivision
*Hospitalists*FP, IM*Medical Specialties*ED*Radiology*Oncology Services
*Gen Surgery*Surg Specialties*Ortho*Pathology*Anesthesia
*OB*FP-OB*Midwives*Peds*Hospitalists*Neonatology
*FP, IM*Peds*Specialists*Ambulatory MDs
Surg DivisionFamily Services
DivisionAmb/Opt.
Services Division
*MEC will review structure and adjust as needed
*Specific specialties will elect their representative to work with section medical director.*Obligatory established contractual reporting requirements will be honored.
STRUCTURE DRAFTDRAFT
CMO
Internal MedicineDivision DirectorHospital Based
Surgery Division DirectorFamily Services Division
Director
Outpatient ServicesDivision Director
Non-hospital based
President Medical Staff
Section Medical Director
Cancer ServicesCardiologyEDHospitalistsIntensivistsSpecialists (see list)
Section Medical Director
AnesthesiaCardiacGeneral SurgeryOrthoPathologyVascularSpecialists (see list)
Section Medical Director
Children's CenterFP- OBMidwivesOBNeonatologyPeds/Hospitalists
Section Medical Director
FPIMPediatricsSpecialists(see list)
SPECIALTIES- DEFINEDSPECIALTIES- DEFINED
MEDICALMEDICAL Behavioral HealthBehavioral Health FPFP IMIM NephrologyNephrology NeurologyNeurology RehabRehab Sleep LabSleep Lab Other as definedOther as defined
SURGICALSURGICAL ENTENT GIGI GYNGYN HandHand Oto-MaxOto-Max PlasticsPlastics UrologyUrology
SPECIALTIES- DEFINEDSPECIALTIES- DEFINED
Out Patient Non-Hospital basedOut Patient Non-Hospital based Allergy/ImmunologyAllergy/Immunology Behavioral Health (OP)Behavioral Health (OP) DermatologyDermatology EndocrinologyEndocrinology RheumatologyRheumatology Others as definedOthers as defined
Structure Cont.Structure Cont.
Ambulatory/Out Pt. Services DivisionAmbulatory/Out Pt. Services Division 300 MDs on Staff only practice in their offices300 MDs on Staff only practice in their offices
Create link to offices to assure that smooth Create link to offices to assure that smooth transition of care from inpatient to outpatient.transition of care from inpatient to outpatient.
There will continue to be specialty-specific There will continue to be specialty-specific recommendations for privileging by the recommendations for privileging by the Chairs/Directors of each section. (already Chairs/Directors of each section. (already doing this)doing this)
Does this do away with Does this do away with the Medical Staff the Medical Staff
Leadership?Leadership? Absolutely not !Absolutely not ! Medical Staff Leaders will still be Medical Staff Leaders will still be
delegated quality and credentialing by delegated quality and credentialing by the Board of Directorsthe Board of Directors
Medical Staff leadership will work Medical Staff leadership will work closely with hospital administration closely with hospital administration and senior clinical leadership on and senior clinical leadership on operational issuesoperational issues
Medical Staff will actually have more Medical Staff will actually have more input with the proposed new structureinput with the proposed new structure
Where Are We Now?Where Are We Now?
Senior Medical Staff Leadership, Senior Medical Staff Leadership, two-year termstwo-year terms
““Super” Medical DirectorsSuper” Medical Directors Created Joint Operations CommitteeCreated Joint Operations Committee
Proposed Changes for Proposed Changes for Phase IIPhase II
Division ChiefsDivision Chiefs MedicineMedicine SurgerySurgery Family ServicesFamily Services Ambulatory /Out Pt. MDsAmbulatory /Out Pt. MDs
Division ChiefsDivision Chiefs Two year terms, renewable (Conclusion of Two year terms, renewable (Conclusion of
extension, 6 months prior to expiration of extension, 6 months prior to expiration of contract)contract)
Nominated by Joint Operations (Board, Admin, Nominated by Joint Operations (Board, Admin, Medical Staff)Medical Staff)
Selection – may be nominated by division - and Selection – may be nominated by division - and Interview ProcessInterview Process
Final Candidate presented to DivisionFinal Candidate presented to Division Approved by Division by simple majorityApproved by Division by simple majority Initially ratified by MEC and Hospital Initially ratified by MEC and Hospital
AdministrationAdministration Report to President of Medical Staff on medical Report to President of Medical Staff on medical
staff concernsstaff concerns Report to CMO for operational issuesReport to CMO for operational issues
Selection of Division Selection of Division ChiefsChiefs
Need to be an Active member of Need to be an Active member of Medical Staff in good standingMedical Staff in good standing
Medical Staff and administrative Medical Staff and administrative experience preferredexperience preferred
Active 1/2 –time practice in communityActive 1/2 –time practice in community If no internal candidate can be found If no internal candidate can be found
and Medical Staff, Board, and and Medical Staff, Board, and Administration agree; then, an outside Administration agree; then, an outside search would be started (e.g., Family search would be started (e.g., Family Services)Services)
Division Chiefs Division Chiefs (continued)(continued)
Responsibilities:Responsibilities: Dyad model with Clinical Director for Dyad model with Clinical Director for
operationsoperations Member of Credentials, MSQRC, Joint Member of Credentials, MSQRC, Joint
Operations and MECOperations and MEC Responsible for QA, credentialing, and Responsible for QA, credentialing, and
strategic planning in their divisionstrategic planning in their division Chair Quarterly QA for their division, and Chair Quarterly QA for their division, and
present issues to MSQRCpresent issues to MSQRC Implementation of policies for MECImplementation of policies for MEC Have at least quarterly Division MeetingsHave at least quarterly Division Meetings
Chief Responsibilities Chief Responsibilities (continued)(continued)
Meetings with Section Directors at Meetings with Section Directors at least quarterly or as neededleast quarterly or as needed
Time commitment 1/3 to 1/2 timeTime commitment 1/3 to 1/2 time Compensation based on description Compensation based on description
and market equivalentand market equivalent Annual ‘360 Review’Annual ‘360 Review’
Section Medical Section Medical DirectorsDirectors Combines current medical directors with section Combines current medical directors with section
chairs where appropriatechairs where appropriate No additional medical directorships at section levelNo additional medical directorships at section level Responsible for QA, Credentialing, and planning in Responsible for QA, Credentialing, and planning in
their sectiontheir section Recommend clinical privilege criteria to Division Recommend clinical privilege criteria to Division
ChiefChief Two-year term (may be renewed similarly to Two-year term (may be renewed similarly to
Division Chiefs)Division Chiefs) Attend division QA Meetings, and other Attend division QA Meetings, and other
appropriate meeting as neededappropriate meeting as needed Dyad Model with Clinical Director/Manager for Dyad Model with Clinical Director/Manager for
operationsoperations
Section Medical Section Medical Directors Cont.Directors Cont.
Nominated by MEC and/or section, and Hospital Nominated by MEC and/or section, and Hospital AdministrationAdministration
Selection and Interview processSelection and Interview process Candidate presented to SectionCandidate presented to Section Confirmed by simple majority of section vote Confirmed by simple majority of section vote Ratified by MEC and Hospital AdministrationRatified by MEC and Hospital Administration Work closely with clinical administration on issues in Work closely with clinical administration on issues in
their areatheir area Compensation, hourly for medical staff issues plus Compensation, hourly for medical staff issues plus
medical director feesmedical director fees Report to Division ChiefReport to Division Chief Annual evaluation by sectionAnnual evaluation by section Not all sections will have their own medical directorNot all sections will have their own medical director
Division StructureDivision Structure
MedicineMedicine HospitalistsHospitalists Medical SpecialtiesMedical Specialties EDED RadiologyRadiology Oncology ServicesOncology Services
SurgerySurgery General SurgeryGeneral Surgery OrthopedicsOrthopedics Surgical Sub-Surgical Sub-
SpecialtiesSpecialties PathologyPathology AnesthesiologyAnesthesiology
Division StructureDivision Structure
Family ServicesFamily Services OB/GynOB/Gyn Peds (In-pt)Peds (In-pt) FP-OBFP-OB MidwivesMidwives Specialty Services Specialty Services
from Children'sfrom Children's
Community Community Out-pt FPsOut-pt FPs Out-pt IMOut-pt IM Out-pt PedsOut-pt Peds Out-pt SpecialtyOut-pt Specialty
New MECNew MEC
MembershipMembership Four, elected Senior Medical Staff - Four, elected Senior Medical Staff -
votingvoting Four Division Chiefs - votingFour Division Chiefs - voting Hospital Senior AdministrationHospital Senior Administration Hospital Board RepresentationHospital Board Representation Credentials Chair - votingCredentials Chair - voting MSQRC Chair - votingMSQRC Chair - voting
How Do We Compare?How Do We Compare?
Recently, several Medical Staff Recently, several Medical Staff leaders, Board and Administration leaders, Board and Administration attended a governance seminarattended a governance seminar
Our proposed new structure was Our proposed new structure was reviewed by Linda Haddad, a leading reviewed by Linda Haddad, a leading consultant on Medical Staff Issuesconsultant on Medical Staff Issues
She was very complimentary of our She was very complimentary of our structure structure
We are actually ahead of the curveWe are actually ahead of the curve
Election of Future* Election of Future* Division ChiefsDivision Chiefs
Nominated by MEC, or divisionNominated by MEC, or division Interview and selection processInterview and selection process Candidate presented to DivisionCandidate presented to Division Voted on by Division (see above)Voted on by Division (see above) Need to meet qualifications of Need to meet qualifications of
Division Chief as outlined previouslyDivision Chief as outlined previously
Question?Question? How do we elect Division ChiefsHow do we elect Division Chiefs
Nominated by Nominating committee or Nominated by Nominating committee or division, Approved by simple majoritydivision, Approved by simple majority
Ratified by MEC and Hospital AdministrationRatified by MEC and Hospital Administration They will have two year contracts, with annual They will have two year contracts, with annual
reviewreview They will have dual reporting to President They will have dual reporting to President
Medical Staff and CMOMedical Staff and CMO They will work closely with clinical directorsThey will work closely with clinical directors Compensated by HospitalCompensated by Hospital Officers will be elected as usual as well as Officers will be elected as usual as well as
members of MSQRC and Credentialsmembers of MSQRC and Credentials
Potential Cost Off-setsPotential Cost Off-sets
Potential reduction in current Potential reduction in current medical director positions/hoursmedical director positions/hours
Potential reduction in hours paid for Potential reduction in hours paid for meeting attendance by medical staffmeeting attendance by medical staff
Stipend from Medical Staff for Stipend from Medical Staff for medical staff issuesmedical staff issues
Benefits for HospitalBenefits for Hospital Aligns Medical Staff leadership to Aligns Medical Staff leadership to
effectively meet challenges in our rapidly effectively meet challenges in our rapidly changing marketchanging market
Establishes a leadership pool of MDs that Establishes a leadership pool of MDs that will be responsible to implement will be responsible to implement operational issues with the medical staffoperational issues with the medical staff
Has the potential to return much more on Has the potential to return much more on the investment, due to easier the investment, due to easier implementation of operational issuesimplementation of operational issues
Creates the framework for true Creates the framework for true partnership with the medical staff partnership with the medical staff
Benefits for the HospitalBenefits for the Hospital
Potential savings based on Chiefs Potential savings based on Chiefs becoming champions:becoming champions:
Decreased Average Length Of StayDecreased Average Length Of Stay Decreased resource utilization through Decreased resource utilization through
standardizationstandardization Improved compliance with Core Measures Improved compliance with Core Measures
and Pay-for-Performance measuresand Pay-for-Performance measures Improved Regulatory ReadinessImproved Regulatory Readiness Potential performance incentive programsPotential performance incentive programs
Next StepsNext Steps
Change Bylaws (Bylaws Committee Change Bylaws (Bylaws Committee working on new changes)working on new changes)
Vote on by Medical Staff (early Fall)Vote on by Medical Staff (early Fall) If approved by Medical Staff, set up If approved by Medical Staff, set up
the interview process for Division the interview process for Division Chiefs and Section Medical DirectorsChiefs and Section Medical Directors
Target Implementation around Target Implementation around January 2007January 2007